Inappropriate and over use of antimicrobials contributes to the emergence of resistant bacteria and causes patient harm. Patients with antimicrobial-resistant infections are more likely to experience ineffective treatment, recurrent infection, delayed recovery or even death.
The aim of Antimicrobial Stewardship Initiative is to improve the safe and appropriate use of antimicrobials, improve patient outcomes and reduce the incidence of antimicrobial resistance in Australian hospitals.
Antimicrobial stewardship (AMS) programs have been shown to decrease inappropriate antimicrobial usage, improve patient outcomes and reduce adverse consequences of antimicrobial use (including antimicrobial resistance, toxicity and unnecessary costs). Along with infection prevention and control, hand hygiene and surveillance, antimicrobial stewardship is considered a key strategy in local and national programs to prevent the emergence of antimicrobial resistance and decrease preventable healthcare associated infection.
National Safety and Quality Health Service Standards: Standard 3
Criterion: Antimicrobial Stewardship
Safe and appropriate antimicrobial prescribing is a strategic goal of the clinical governance system.
From January 2013 health services will be accredited against the National Safety and Quality Health Service Standards. Safety and Quality Improvement Guides are available to assist health services implement each Standard including Standard 3 which contains a criterion on AMS. An accreditation workbook is also available.
The intent of the AMS criterion is to ensure appropriate prescribing of antimicrobials as part of the broader systems within a health service organisation to prevent and manage health care associated infections and improve patient safety and quality of care.
The antimicrobial stewardship criterion requires that all healthcare services:
- Have an antimicrobial stewardship program in place
- Provide clinicians prescribing antimicrobials access to current endorsed Therapeutic Guidelines on antimicrobial usage
- Undertake monitoring of antimicrobial usage and resistance
- Take action to improve the effectiveness of antimicrobial stewardship.
The AMS criterion aligns closely with Standard 4: Medication Safety and the actions should be considered in relation to the criterion and actions within that Standard and Standard 1: Governance for Safety and Quality in Health Service Organisations.
Antimicrobial Stewardship in Australian Hospitals 2011
This publication provides clinicians and health administrators with the evidence and requirements for hospital AMS programs.
It is available to download in full, or by chapter. The publication provides guidance on developing and introducing a hospital AMS program. It describes the structure, governance, and resources needed for an effective program, along with those strategies shown to influence antimicrobial prescribing and reduce inappropriate use.
Antimicrobial Prescribing E-learning Modules
The Commission and NPS MedicineWise have developed a series of e-learning modules on antimicrobial prescribing.
The modules are aimed at prescribers in their first 2 years out of medical school, as well as nurse practitioners, hospital pharmacists and university students. They modules address specific areas where antimicrobial use in hospitals is suboptimal.
The modules can be accessed here:www.nps.org.au/health_professionals/online_learning
Tools and resources to support Antimicrobial Stewardship
Examples of resources that have been used in Australian hospitals to support stewardship programs, including:
- Committee terms of reference
- Restricted antimicrobial policies and forms
- Clinical Prescribing guidelines including hospital and community acquired pneumonia)
- Surgical prophylaxis guidelines
Monitoring usage
Monitoring usage of antimicrobials is one of the key requirements of an AMS program. This is important for understanding antimicrobial resistance and measuring the effects of stewardship interventions.
Links to tools for monitoring usage
Links to National and state antimicrobial surveillance data
- NAUSP
- CHRISP
- TIPCU
Publications
McNeill V, Cruickshank M, Duguid M. Safer use of antimicrobials in hospitals: the value of antimicrobial usage data. MJA 2010;193(8); S114-S117